The primary aims of the study is to determine the effect of a program of systematic oral care on reducing exposure to pathogens in the critical care patient population. Additionally the study compares the risk of developing nosocomial pneumonia in intubated and non-intubated patients. The study will also determin is adding alcohol free chlorhexidine oral spray further reduces risk of infection. Nurse care providers will be instructed by a dentist and dental hygienist and this instruction will be compared to the traditional nurse to nurse instruction. The research subjects are patients admitted to the Intensive Care Units (ICU) of four community hospitals. Two hospitals will be control and two hospitals will be treatment. The control will continued routine ICU oral care while the treatment ICU will be instructed in the systematic oral care program. The patients will be examined and tested on Day 0, 3, and 5 of their ICU admission. All testing is non-invasive, Beck oral assessment scores, mucosal plaque scores, risk assessment scores, clinical pulmonary infection scores. Additionally saliva and plaque specimens will be assayed for the presence of pathogens. This fiscal year, 2004, has been devoted to getting Internal Review Board approval at the four area hospitals. Data collection will start October, 2004.